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World Journal of Surgery

, Volume 39, Issue 12, pp 3023–3027 | Cite as

Variation on a Theme: Alternative to Plastic Bag in ALPPS Procedures: Feasibility and Clinical Safety of COVA+™ Membrane in ALPPS Procedures

  • Raffaele Brustia
  • Olivier Scatton
  • Olivier SoubraneEmail author
Innovative Surgical Techniques Around the World

Abstract

Background

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) got wide success among hepatic surgeons as an efficient way to shorten to 7 days from the 4 weeks interval of classic 2-staged hepatectomy. The main disadvantage of ALPPS is the onset of inflammatory adhesions, particularly on the hepatic pedicle region, previously dissected. The aim of the study is the evaluation of a resorbable collagen membrane (CM) indicated in the prevention of postoperative adhesions as an alternative to the use of a plastic bag (PB) during ALPPS procedure.

Methods

All patients undergoing ALPPS procedure in our department were prospectively included in a database. At the end of the first surgery, at least one resorbable CM (COVA+™, Biom’Up, France) was placed instead of a PB. Intraoperative adhesions during the second step and clinical short-term safety were assessed.

Results

Ten patients with a mean age of 57.5 years underwent a 2-staged hepatectomy through ALPPS approach. At the second stage, 90 % of the patients experienced either grade-0 (no adhesion) or grade-I adhesions (mild adhesions easily divided). None of the reported complications were related to the use of the CM.

Conclusion

To our knowledge, this is the first clinical study evaluating the use of an anti-adhesion resorbable CM as a safe and efficient alternative to PB in ALPPS procedures.

Keywords

Fibrin Sealant Future Liver Remnant Collagen Membrane Postoperative Adhesion Portal Vein Ligation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

Supplementary material 1 (M4V 15120 kb)

References

  1. 1.
    Schnitzbauer AA, Lang SA, Goessmann H et al (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255:405–414CrossRefPubMedGoogle Scholar
  2. 2.
    Torres OJM, De Souza Martins F, Oliveira CVC et al (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazialian experience. Arq Bras Cir Dig 26:40–43CrossRefPubMedGoogle Scholar
  3. 3.
    Armoiry X, Viprey M, Constant H et al (2013) Potential interest of a new absorbable collagen membrane in the prevention of adhesions in paediatric cardiac surgery: a feasibility study. Arch Cardiovasc Dis 106:433–439CrossRefPubMedGoogle Scholar
  4. 4.
    Mueller MD, Tschudi J, Herrmann U et al (1995) An evaluation of laparoscopic adhesiolysis in patients abdominal pain. Surg Endosc 9:802–804PubMedGoogle Scholar
  5. 5.
    Dupré A, Lefranc A, Buc E et al (2013) Use of bioresorbable membranes to reduce abdominal and perihepatic adhesions in 2-stage hepatectomy of liver metastases from colorectal cancer: results of a prospective, randomized controlled phase II trial. Ann Surg 258:30–36CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Raffaele Brustia
    • 1
    • 3
  • Olivier Scatton
    • 1
    • 3
  • Olivier Soubrane
    • 2
    • 4
    Email author
  1. 1.Department of Hepatobiliary Surgery and Liver TransplantationHôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisParisFrance
  2. 2.Department of Hepatobiliary Surgery and Liver TransplantationHôpital Beaujon, Assistance Publique-Hôpitaux de ParisClichyFrance
  3. 3.Université Pierre et Marie CurieParisFrance
  4. 4.Université DiderotParisFrance

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